NICUs fight for cases as Deaconess loses surgeons

Dozens of babies born months early, too little and too weak to breastfeed, their tiny lungs unable to capture ample oxygen, rest and grow inside special hospital bassinets. Their parents dream of the day when they can bring them home from these neonatal intensive care units, called NICUs.

Now an ongoing and increasingly ugly rift between Spokane’s two major hospitals has placed some of these families in the cross hairs of competition.

A key surgery group that saves dozens of premature infants each year has ruptured. Its doctors have taken sides, amid accusations of favoritism at the expense of patient care and safety.

In interviews and conversations, medical personnel and officials at Deaconess Medical Center worry that Providence Sacred Heart Medical Center is siphoning patients and wants to use its children’s hospital as leverage to dominate high-risk births and critical care for premature babies.

Their counterparts at Sacred Heart accuse Deaconess of pressuring physicians to keep patients at the smaller hospital against their judgment.

It has been unsettling for the medical community.

It’s been frightening for parents like Brandy Kramer.

After a nerve-wracking pregnancy ended in June with an emergency cesarean section, she found herself the mother of twin girls born at just 26 weeks and grasping for life after surviving a rare condition called twins-transfusion syndrome.

Lily arrived 1 pound 10 ounces. The nurses at Deaconess rushed her to a ventilator. Dahlia was born a minute later, 1 pound 14 ounces. She was whisked to her sister’s side and hooked to a machine to assist her breathing.

Kramer remembers how vulnerable her daughters seemed, the tubes and gauze, eyes scrunched shut, and their glistening skin.

After Kramer was discharged, she and her husband, Vinny Kramer, would drive every day from their Coeur d’Alene home to the hospital. They would pull on gloves and change diapers. Whisper to the girls.

They quickly fell into the embrace of the Deaconess NICU staff.

And then Dahlia got sick. Her abdomen became distended and doctors worried that her bowel might perforate.

Pediatric surgeon Dr. James Fischer wanted her put on strong antibiotics in hopes of avoiding surgery. Days later he left her in the care of colleagues and went on a scheduled vacation.

Dahlia had a medical condition called necrotizing enterocolitis. Part of her intestine was dying.

During Fischer’s absence it was decided that Dahlia would have surgery. Another surgeon in his practice was summoned to do the operation, a serious yet common procedure performed on dozens of premature babies every year at Deaconess.

About this same time, however, Fischer’s colleagues acted upon concerns they say they had harbored for months about Deaconess’ quality of care. They decided to resign their medical privileges at Deaconess and only perform such surgeries at Sacred Heart.

Dahlia would have to be moved.

Ann Seaburg, senior director of women’s and children’s services at Deaconess, said, “What could possibly justify moving a 2 pound baby by ambulance six blocks away for a surgery that has been done here hundreds of times?

“Just what is the issue here? Perhaps it’s not as convenient for the surgeon? That shouldn’t be the determining factor.”

NICU care offered by both for decades

Though the surgery group is owned by Sacred Heart, it was contractually bound to work at Deaconess, too.

A 2005 agreement signed by the hospitals’ chief executives closed the Deaconess pediatric unit and allowed its staff to migrate to Sacred Heart Children’s Hospital.

The five-year deal included an important proviso: Sacred Heart’s specialists would continue performing surgeries on premature babies at Deaconess.

NICUs are big moneymakers for hospitals. Regardless of a mother’s ability to pay her own hospital care, babies will be covered by Medicaid, and intensive care can run hundreds of thousands of dollars.

After years of losing money, Deaconess sold to for-profit Community Health Systems Inc. in 2008, and as the sale jelled, Sacred Heart called Deaconess managers to a meeting.

Peggy Mangiaracina, executive director of Sacred Heart Children’s Hospital, presented what amounted to a list of conditions if Sacred Heart was to continue providing surgical support to Deaconess’ NICU: The hospital needed radiologists and anesthesiologists specially trained in pediatrics, better equipment and other fixes.

Seaburg was surprised by the demands, but after the conditions were met the issues never resurfaced.

Then this year the sides tried to work out a new NICU surgery agreement.

Sacred Heart offered what Mangiaracina described as a fair-market contract requiring Deaconess to pay $525,000 per year. Deaconess declined.

As those dealings deteriorated, the surgery group began expressing new concerns about Deaconess.

Dr. Paul Thorne said he had been pressured by Deaconess staff to keep patients at Deaconess even if they would be better served at Sacred Heart.

Thorne recounted one baby with multiple congenital abnormalities whom he wanted to transfer to Sacred Heart. When his request met resistance, Thorne said he insisted and eventually the transfer was made. An emergency operation was performed on a Saturday night that required two pediatric specialists and a hastily arranged surgical team; it was a success.

“We couldn’t have pulled that off at Deaconess,” Thorne said.

Trouble caused by ‘political junk’

Brandy Kramer, meanwhile, was faced with a dilemma.

She was upset that surgeons wouldn’t operate on Dahlia at Deaconess. But she put her trust in Dr. Winston Chan, one of Fischer’s colleagues.

“As a mom I had to give control to these doctors and nurses and trust that they’re going to do what’s right for our family,” she said.

Seaburg supported Kramer’s decision but was privately upset by the episode.

“The bottom line is that we’ve been doing this kind of care here for 35 years and doing a damn good job of it,” she said.

At Sacred Heart, Chan successfully cut out seven inches of Dahlia’s bowel, stitched part of her intestine into her skin and attached a colostomy bag.

Dahlia spent three weeks recovering at Sacred Heart while Lily – at the insistence of the Kramers – stayed at Deaconess, where she was thriving.

Brandy Kramer ran back and forth between the NICUs, exhausted and worried.

Nurses at both hospitals tried to be supportive, though Kramer was bothered by the subtle suggestions that she should reunite Lily and Dahlia.

“I kept thinking the entire time this was happening that it was crazy what was happening to me and that my babies couldn’t be together,” she said.

When she spoke to her doctors about it, one of them called it “political junk” that has created a fissure in the Spokane medical community, she said.

“You could tell it was weighing on the doctors as well,” Kramer said.

When it was time, Brandy returned Dahlia to Deaconess.

When Fischer, the twins’ original doctor, returned, he said he was offended by the actions of his colleagues.

He was then presented with an ultimatum by Sacred Heart executives, he said, to resign privileges at Deaconess like the rest of his colleagues. He walked away from his practice instead and went to work for Deaconess.

“That’s wrong, and I didn’t deserve that,” he said.

He performed a second surgery on Dahlia with success.

Thorne and Chan defend their actions. They said difficult and complex surgeries on children should be done at Sacred Heart with its vast network of pediatric specialists.

Thorne said none of the surgeons were “coerced, guided or directed to not perform surgery at Deaconess.”

Fischer said he wants to help Deaconess preserve its NICU, which opened in 1975.

Sacred Heart insists it does not want the Deaconess NICU to close.

Seaburg said Deaconess intends to be successful but would like to re-establish a relationship with the Sacred Heart surgeons.

“We’re committed to the high quality care we offer. We want to stay local, but if we have to go outside to bring in surgeons and others to help us provide the best level of care, we will.”